Revenue Cycle Specialist resume examples

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Skillful Revenue Cycle Specialist resume

SHAWNA BUNTING
Professional Summary
Well versed and accomplished Client Relations Manager adept at developing often complex client proposals. Specializes in developing and nurturing productive client relationships and managing key accounts. 


Skills
  • New Business Development 
  • Process improvement strategies
  • Healthcare billing proficiency
  • Lean Six Sigma methodologies and applications
  • Productivity improvement specialist
  • Leadership/communication skills
  • Extensive medical terminology knowledge
  • Strong Business Acumen
  • Operations management
  • Lean manufacturing and design
  • Cost reduction and containment
  • Change management
  • Negotiations expert
  • Strategic planning
  • Client relationships
  • Self-motivated
  • Personal and professional integrity
  • Microsoft Office Suite expert
  • Relationship and team building
  • Troubleshooting and problem solving
  • Critical thinking proficiency
  • Personable
  • Highly analytical and meticulous
  • Flexible 
Professional Experience
Client Relationship Manager Nov 2015 to Current
 Cardinal Health － Lewisville, TX
  • Owns client relationship and acts as the escalation point for all programs services, projects and operational performance issues.
  • Develops lasting relationships that foster client ties.
  • Directs planning, budgeting, vendor selection and quality assurance efforts.
  • Analyzes program processes and makes recommendations for improving efficiency, resulting in cost reduction both internally and for external clients.
  • Recommends process and systems improvements such as implementing Lean Six Sigma and Kaizen methodologies to help our company's operations run more efficiently.
  • Interacts with clients and projects sponsors, stakeholder and various project members to ensure that specified business needs are met; assists in post-implementation analysis to ensure that requirements are fulfilled.
  • Defined clear targets and objectives and communicated them to other team members.
  • Assists in the development, refinement, validation or ensures completions of all projects; manages various work plans to ensure project commitments are met on time.
  • Delivers engaging, informative, well-organized presentations.
Quality Assurance Analyst Oct 2014 to Nov 2015
 CCS Medical, Inc. － Farmers Branch, TX
  • Provided feedback to assist in the creation of performance improvement goals and the development of training programs.
  • Reviewed all billing CPT codes and ICD-9/ ICD-10 coding to ensure all possible revenue was recorded for accuracy/ Federal auditing on a daily basis.  
  • Participated in coding, documentation, Quality and Risk Adjustment educational activities.
  • Developed a streamlined task system to provide more effective workflows for both peers and management staff.  
  • Identified and documented detailed business rules and use cases based on requirements analysis. 
  • Documented business workflows for stakeholder review.
Account Manager Oct 2013 to Oct 2014
 CCS Medical, Inc. － Farmers Branch, TX
  • Managed over 1000 accounts/ contact referral sources building revenue for the company by at least 5% monthly.
  • Implemented strict federal Healthcare policy guidelines for over 1000 patients.
  • Continuous achieved revenue goals, production, and performance objectives.
  • Accessed and analyzed all CCS Medical Health contracts for accurate account determinations and resolutions.
  • Accountable for promoting, and delivering a portfolio of products and services to accounts in targeted assigned market segments, and contributing to CCS Medical sales and profit goals while working closely with the outside sales teams.
  • Responsible for implementing all business-building and relationship-building expectations with uniquely assigned accounts and customers. 
  • Provided an exemplary level of service to clients to both maintain and extend the relationships for future business opportunities. 
  • Consistently met and exceeded department expectations for productivity and accuracy levels.
Revenue Cycle Specialist Apr 2008 to Oct 2013
 St John Health System － Tulsa, OK
  • Processed monthly reports for department performance.
  • Demonstrated analytical and problem-solving ability by addressing barriers to receiving and validating accurate HCC information.
  • Recorded and filed patient data and medical records.
  • Examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered.
  • Acquired insurance authorizations for procedures and tests ordered by the attending physician. 
  • Acted as a liaison between the business department, billers and third party payers in resolving billing and reimbursement accuracy.
  • Interpreted medical reports to apply appropriate ICD-9, CPT-4 and HCPCS codes. 
  • Thoroughly reviewed remittance codes from EOB's/AR's.
  • Evaluated the accuracy of provider charges, including dates of service, procedures, level of care, locations, diagnoses, patient identification and provider signature.
  • Submitted refund requests for claims paid in error. 
Credit Collection Consultant Nov 2006 to Aug 2008
 HSBC Card Services － Tulsa, OK
  • Located and monitored overdue accounts, using computers, various software and automated systems.
  • Recorded information about financial status of customers and status of collection efforts.
  • Reviewed customer accounts and results regularly to determine whether life changes, economic developments or financial performance indicated a need for plan revision.
  • Negotiated credit extensions when necessary.
  • Monitored risk accounts on a weekly, monthly, quarterly and annual basis.
  • Maintained confidentiality of bank records and client information.
  • Advised customers of necessary actions and strategies for debt repayment.
  • Arranged for debt repayment or establish repayment schedules, based on customers' financial situations.
Customer Service Manager Jan 2006 to Nov 2006
 Reasor's － Tulsa, OK
  • Supervised all employees on shift to ensure completion of all duties and tasked assigned.
  • Improved service quality and increased sales by developing a strong knowledge of the company's products and services.
  • Responsible for supervising and maintaining the front end of the store and employees, while assisting customers and providing them with great customer care.
  • Handled customer complaints and ensured customer satisfaction on store products and overall shopping experience.
  • Addressed negative customer feedback immediately.
  • Assisted with developing and implementing policies, procedures and process improvement initiatives to improve retention rates and increase customer satisfaction.
  • Developed a rapport with the customer base by handling difficult issues with professionalism.
  • Recommended changes to existing methods to increase the accuracy, efficiency and responsiveness of the customer service department.
  • Trained and cross-trained both new and existing employees.
Education
Bachelor of Science Program, Business Administration - Entrepreneurship 2013 Rogers State University － Claremore, OK
Associate of Science Program, Business Administration 2009 Tulsa Community College － Tulsa, OK
Certifications
  • Certified Kaizen Facilitator (CKF) 
  • Design For Six Sigma Certified (DFSSC) 
  • Executive Management Certified (EMC) 
  • Project Management- Lean Process Certified (PM-LPC) 
  • Six Sigma Champion Certified (SSCC) 
  • Six Sigma Green Belt Certified (SSGBC) 
  • Six Sigma Lean Black Belt Professional (LBBP)
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Job-winning Revenue Cycle Specialist resume

Misty Bailey
Professional Summary
Organized Coordinator with foundation in records management. Experienced in billing and collection procedures. Advanced medical terminology knowledge. Coordinator with background in billing and collections, records management and maintenance and appointment setting. Medical billing and coding specialist with 13 years providing administrative and patient support in a medical office setting. Advanced knowledge of private insurance processes and codes. Patient-focused Medical Administrative Assistant and Billing Coordinator with more than 17 years experience working in a busy medical office serving diverse populations. Efficient Medical Administrative Assistant skilled in tackling administrative and patient-oriented tasks in a fast-paced environment. Medical Administrative Assistant adept at verifying insurance coverage, reviewing records, charge entry, claim coding and scheduling appointments. Previously supported up to 8 providers in a busy medical office setting and served as Revenue Cycle Specialist for multiple offsite locations. Medical Billing Specialist - Collector - Administrative Assistant
Skills
  • Excellent customer service skills
  • Experience using multi line phone systems with managing heavy call volume
  • Medical terminology expert
  • Billing and collection procedures expert
  • Records management professional
  • Hospital inpatient and outpatient records
  • Inpatient records coding proficiency
  • Records maintenance professional
  • Outpatient surgery coding specialist
  • Patient referrals expert
  • Familiar with commercial and private insurance carriers
  • Patient chart auditing ability
  • Insurance and collections procedures
  • Understands insurance benefits
  • Composed and professional demeanor
  • Research and data analysis
  • Office management professional
  • Excellent problem solver
  • Resourceful and reliable worker
  • Adept multi-tasker
  • Close attention to detail
  • Office support (phones, faxing, filing)
  • Excellent verbal communication
Work History
Inquiry Resolution Specialist, 06/2015 to Current
 Conifer Health Solutions – 3560 Dallas Pkwy Frisco, TX 75034
  • Precisely review patient disputes, documentation and patient claims.
  • Thoroughly research diagnoses and/or medical procedures to expand skills and knowledge.
  • Meticulously identify and rectify inconsistencies, deficiencies and discrepancies in medical documentation.
  • Verified patients' eligibility and claims status with insurance agencies.
  • Diligently file and follow up on third party claims.
  • Performed qualitative analysis of records to ensure accuracy, internal consistency and correlation of recorded data. Including but not limited to reaching out to the facility for medical records and or facility DRA for Charge Audits or Quality of Care Reviews.
  • Research questions and concerns from patients and provided detailed responses.
  • Review and analyze coding of diagnostic and treatment procedures contained in outpatient medical records for accuracy.
  • Maintained strict patient/client confidentiality.
  • Interact with facilities and other medical professionals regarding billing and documentation policies, procedures and regulations.
  • Precisely evaluate and verifiy benefits and eligibility.
  • Identify and resolved patient billing and payment issues.
  • Examined patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under their policies when applicable.
  • Treat all patients/clients, visitors, peers and staff in a pleasant and courteous manner.
Revenue Cycle Specialist, 06/2014 to 07/2015
 StratFi Health – 6400 Pinecrest Dr #300 Plano, TX 75024
  • Precisely completed appropriate claims paperwork, documentation and system entry.
  • Correctly coded and billed medical claims for various hospital and nursing facilities.
  • Thoroughly researched newly identified diagnoses and/or medical procedures to expand skills and knowledge.
  • Assisted in the maintenance of medical charts and/or electronic medical record (filing, Op Reports, test results, home care forms).
  • Meticulously identified and rectified inconsistencies, deficiencies and discrepancies in medical documentation.
  • Maintained updated knowledge of coding requirements, through continuing education and certification renewal.
  • Verified patients' eligibility and claims status with insurance agencies.
  • Diligently filed and followed up on third party claims.
  • Assigned appropriate medical codes with a 98 percent accuracy rate.
  • Performed qualitative analysis of records to ensure accuracy, internal consistency and correlation of recorded data.
  • Researched questions and concerns from providers and provided detailed responses.
  • Accurately selected the proper descriptive code when more than one anatomical location was indicated.
  • Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
  • Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
  • Maintained strict patient and physician confidentiality.
  • Resourcefully used various coding books, procedure manuals and on-line encoders.
  • Actively maintained current working knowledge of CPT and ICD-9 coding principles, government regulation, protocols and third party requirements regarding billing.
  • Conscientiously reviewed medical record information to identify appropriate coding based on CMS HCC categories.
  • Managed collections claims for unpaid bills against the estates of debtors.
  • Interacted with providers and other medical professionals regarding billing and documentation policies, procedures and regulations.
  • Accurately posted and sent out all medical claims.
  • Submitted electronic/paper claims documentation for timely filing.
  • Accurately posted and sent out all medical claims.
  • Precisely evaluated and verified benefits and eligibility.
  • Responded to correspondence from insurance companies.
  • Posted and adjusted payments from insurance companies.
  • Identified and resolved patient billing and payment issues.
  • Maintained and updated collections tracking spreadsheet to help organize payment information.
  • Confidently and adeptly handled claim denials and/or appeals.
  • Evaluated patients' financial status and established appropriate payment plans.
  • Reviewed and resolved claim issues captured in TES/CLAIMS edits and the clearing house.
  • Examined patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under their policies when applicable.
  • Updated patient financial information to guarantee accuracy.
  • Treated all patients, their families, visitors, peers, staff and providers in a pleasant and courteous manner.
  • Compiled and tracked outstanding balances owed to medical facilities.
  • Printed and reviewed monthly patient aging report and solicited overdue payments.
  • Accurately posted claims, office visits and payments for assigned carriers.
  • Prepared billing correspondence and maintained database to organize billing information.
Billing Coordinator, 02/2008 to 06/2014
 Baylor Family Medicine at Frisco – Frisco, TX
  • Scheduled appointments, registered patients and distributed sample pharmaceuticals as prescribed.
  • Coded inpatient charts at a rate of number per hour or number per day.
  • Precisely completed appropriate claims paperwork, documentation and system entry.
  • Thoroughly researched newly identified diagnoses and/or medical procedures to expand skills and knowledge.
  • Correctly coded and billed medical claims for processing and reprocessing.
  • Professionally and courteously verified appointment times with patients.
  • Adeptly managed a multi-line phone system and pleasantly greeted all patients.
  • Verified patients' eligibility and claims status with insurance agencies.
  • Researched questions and concerns from providers and provided detailed responses.
  • Accurately selected the proper descriptive code when more than one anatomical location was indicated.



  • Managed collections claims for unpaid bills against the estates of debtors.
  • Interacted with providers and other medical professionals regarding billing and documentation policies, procedures and regulations.
  • Accurately posted and sent out all medical claims.
  • Precisely evaluated and verified benefits and eligibility.
  • Responded to correspondence from insurance companies.
  • Identified and resolved patient billing and payment issues.
  • Confidently and adeptly handled claim denials and/or appeals.
  • Evaluated patients' financial status and established appropriate payment plans.


  • Examined patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under their policies when applicable.
  • Updated patient financial information to guarantee accuracy.
  • Treated all patients, their families, visitors, peers, staff and providers in a pleasant and courteous manner.
  • Compiled and tracked outstanding balances owed to medical facilities.
  • Printed and reviewed monthly patient aging report and solicited overdue payments.
  • Prepared billing correspondence and maintained database to organize billing information.
Billing/Referral Coordinator, 09/2002 to 06/2007
 Digestive Health Associates of Texas – Dallas, TX
  • Scheduled appointments, registered patients and distributed sample pharmaceuticals as prescribed.
  • Correctly coded and billed medical claims.
  • Professionally and courteously verified appointment times with patients.
  • Adeptly managed a multi-line phone system and pleasantly greeted all patients.
  • Verified patients' eligibility and claims status with insurance agencies.
  • Prepared patient charts accurately and neatly for the clinic.
  • Prepared patient charts, pre-admissions and consent forms as necessary.
  • Maintained strict patient and physician confidentiality.
  • Interacted with providers and other medical professionals regarding billing and documentation policies, procedures and regulations.
  • Accurately posted and sent out all medical claims.
  • Precisely evaluated and verified benefits and eligibility.
  • Responded to correspondence from insurance companies.
  • Identified and resolved patient billing and payment issues.
  • Confidently and adeptly handled claim denials and/or appeals.
  • Evaluated patients' financial status and established appropriate payment plans.
  • Examined patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under their policies when applicable.
  • Updated patient financial information to guarantee accuracy.
  • Treated all patients, their families, visitors, peers, staff and providers in a pleasant and courteous manner.
  • Prepared billing correspondence and maintained database to organize billing information.
Education
GED: 2000
 Rowlett High School - Rowlett, TX
Accomplishments

Rookie of the Month Award- July 2015

Team Player Award- October 2015

Dispute Destroyer Award- February 2016

Awards

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